Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel
Open accessAbstract
Noncognitive neuropsychiatric symptoms ( NPS ) of dementia (aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, disinhibition) affect individuals with dementia nearly universally across dementia stages and etiologies. NPS are associated with poor outcomes for individuals with dementia and caregivers, including excess morbidity and mortality, greater healthcare use, and earlier nursing home placement, as well as caregiver stress, depression, and difficulty with employment. Although the F ood and D rug A dministration has not approved pharmacotherapy for NPS , psychotropic medications are frequently used to manage these symptoms, but in the few cases of proven pharmacological efficacy, significant risk of adverse effects may offset benefits. There is evidence of efficacy and limited potential for adverse effects of nonpharmacological treatments, typically considered first line, but their uptake as preferred treatments remains inadequate in real‐world clinical settings. Thus, the field currently finds itself in a predicament in terms of management of these difficult symptoms. It was in this context that the U niversity of M ichigan P rogram for P ositive A ging, working in collaboration with the J ohns H opkins A lzheimer's D isease R esearch C enter and C enter for I nnovative C are in A ging sponsored and convened a multidisciplinary expert panel in D etroit, M ichigan, in fall 2011 with three objectives: to define critical elements of care for NPS in dementia; to construct an approach describing the sequential and iterative steps of managing NPS in real‐world clinical settings that can be used as a basis for integrating nonpharmacological and pharmacological approaches; and to discuss how the approach generated could be implemented in research and clinical care.
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Care home residents with agitation often find sitting still difficult and therefore might not be included in activities.
“Care home residents with agitation often find sitting still difficult and therefore might not be included in activities.217, 218”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [217]
The DICE Approach (Steps 1–3; page unavailable) discusses agitation and recommends meaningful activities, but does not say that agitated care-home residents have difficulty sitting still or are excluded from activities as a result. Searches for sitting still, restlessness, and activity participation found no passage making that connection. (LLM, conf=0.73)
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- Authors
- Kales, H. C., Gitlin, L. N., Lyketsos, C. G., & Dementia, T. D. E. P. O. T. A. A. M. O. T. N. S. O.
- Affiliations
- University of Michigan (US)
- Johns Hopkins University (US)
- Corresponding author
- Kales, Helen C.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2014-03-17
- Volume
- 62
- Issue
- 4
- Pages
- 762-769
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC4146407
- OpenAlex
- W1976117775
- Cited by
- 575
- References
- 38
- Citations by year
- 2026: 27 · 2025: 43 · 2024: 60 · 2023: 47 · 2022: 53 · 2021: 58 · 2020: 54 · 2019: 38 · 2018: 55 · 2017: 48 · 2016: 49 · 2015: 29 · 2014: 13
- FWCI
- 6.38
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (NIH)
- Alzheimer's Association
- National Institute of Mental Health
- National Institute on Aging
- Associated Jewish Federation of Baltimore
- Weinberg Foundation
- Forest
- GlaxoSmithKline
- Eisai
- Pfizer
- AstraZeneca
- Lilly
- Ortho-McNeil
- Bristol-Myers
- Novartis
- National Football League (NFL)
- Elan
- Functional Neuromodulation Inc.
- Johns Hopkins Alzheimer's Disease Research Center (P50AG005146)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- dementia, agitation, aggression, depression, anxiety, delusions, hallucinations, apathy, disinhibition, psychotropic drugs, adverse effects, non-pharmacological treatment, integrated treatment, clinical guidelines, caregiver burden, nursing home admission
- MeSH terms
- Behavior Therapy, Crisis Intervention, Dementia, Humans, Neuropsychological Tests, Severity of Illness Index, Practice Guidelines as Topic, Disease Management
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